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Phase II Cards from RC > LS, Discospondylitis, Rando > Flashcards

LS, Discospondylitis, Rando Flashcards

1
Q

Antibiotic recommended for bacterial encephalomyelitis?

A

metronidazole, enrofloxacin, chloramphenicol, TMS, 3rd gen cephalosporin

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2
Q

antibiotic recommended for discospondylitis?

A

1st gen cephalosporins (clavamox sound) - 17% Staph resistant
Cephalexin, cefazolin, TMS

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3
Q

what dog breeds most often diagnosed with disconspondylitis? prognosis?

A

Great Dane, Labs, Rott, GSD, Doberman, Eng Bulldogs

fair to good uncomplicated

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4
Q

what are complications of sx for LSS?

A

trauma, compression, implant failure, inadequate bony fusion, adjacent segment disease

infections (23% positive cultures of disc)
seroma
instability
neuro deterioration

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5
Q

what is the overall prognosis?

A

excellent to good 77% (some papers report higher)

73% (Dorsal lam + discectomy)

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6
Q

what is recurrence rate?

A

3-54.5% (one study 16.7% normal function, 54% if only had mild improvement)

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7
Q

compare presentations of BP avulsion injuries:
1) avulsion cranial (C5-C7)
2) avulsion caudal )C8-T2)
3) all (C6-T2)

A

1) musculocutaneous, axillary, subscapular, suprascapular
- loss of shoulder movement and elbow flexion
- few CS

2) radial, median, ulnar (radial nerve signs more common - 92% of cases)
- flexed limb but no weight bearing as can’t extend carpus/digits
- Horner’s and/or loss cutaneous trunci (C8-T1)

3) all nerves
- drag limbs knuckled over, shoulder more neutral
- sensory deficits common

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8
Q

what are signalment/common breeds that get steroid-responsive menigitis-arteritis?

A

young 6-18 months
74.2% are < 1year

Beagles, boxers, BMD, weimaraners, Nova scotia duck retrievers

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9
Q

presentation and CSF findings between the 2 forms (steroid-responsive menigitis-arteritis)?

A

acute form:
- hyperesthesia, cervical rigiditly, stiff gait, fever
- guarding neck
- polymorphonuclear nondegenerative, pleocytosis, increased TP, ~ RBC

chronic form:
- paresis, ataxia, menace deficit, anisocoria, vestibular signs
- primary mononuclear cells or mixed cells, normal or mildly increased TP

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10
Q

what BW can help to monitor therapy (steroid-responsive menigitis-arteritis)?

A

acute form:
-c-reactive protein

chronic form:
- macroglobulin

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11
Q

what are the components and locations of ventriculoperitoneal shunt?

A

ventricular catheter
control valve
abdominal or distal catheter

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12
Q

ventriculoperitoneal shunt - complications of placement?

A

shunt infection, shunt malfunction/blockage, under shunting, catheter migration, control valve function, seizures

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13
Q

what are the systems described to evaluate brain sx post-op?

A

response criteria in solid neoplasms (RECIST)
response assessment in neuro-oncology (RANO)
MacDonal criteria

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14
Q

what is diagnostic yield for stereotactic biopsy? morbidity rates?

A

> 90% especially for cancer

morbidity rates up to 27% reported (but newer rates ~5%)

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15
Q

what are high risk breeds of LSS?

A

GSD, Dobie, Rottie, BMD, Dalmation, Boxer, Irish Setter, lab

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16
Q

what is intermittent claudication?

A

paroxysmal manifestations - caudal lumbar pain or PL cramping, pain, weakness from vascular compromise or compression of nerve roots of cauda equina

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17
Q

what C.S/presenting complaint in dog with LSS have worse prognosis?

A

urinary and/or fecal incontinence

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18
Q

what congenital cranium abnormalities may benefit from sx?

A

intracranial arachnoid diverticula
dermoid/epidemoid cysts
congenital hydrocephalus
disorders associated with malformation of caudal cranial fossa and craniocervical junction

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19
Q

Signalment for calcinosis circumscripta?

A

< 1yr, large breed. (GSD overrepresented)

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20
Q

prognosis with surgery for calcinosis circumscripta?

A

no recurrence upto 24 mo post dorsal laminectomy

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21
Q

what causes osteochondroma?

A

arise secondary to migration of chondrocytes from physeal region into metaphyseal region of bone

continued cartilage formation

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22
Q

prognosis for osteochondroma?

A

if a accessible to excise - favorable

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23
Q

what are the 3 stages of distemper infection?

A

gray matter disease:
- ~1 week post infection - nonsuppurative ME
- often die within 2-3 weeks (often with seizures)
- may recover or progressive to next

white matter disease:
- ~3 weeks post infection
- most common form (likely due to subclinical GM stages)
- may recover with minimal CNS injury or infection

necrotizing meningoencephalitis
- ~4-5 weeks post infection
- nonsuppurative inflammation
- uveitis, chonoretinitis
some deteriorate and die; others slowly recover

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24
Q

distemper infection - diagnostics? treatment?

A

RT - PCR (whole blood, urine, CSF)
IHC antigen biopsy - nasal mucosa, foot pad epithelium, haired skin

supportive treatment

prognosis guarded

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25
Q

list surgical techniques for treating brachial plexus avulsions

A

neurotization (re-enervation of denervated motor or sensory end organ (sacrifice donor nerve))

reimplantation - through hemilaminectomy

end to end suturing/anastomosis (without graft)

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26
Q

what is the prognosis for avulsion injuries to the brachial plexus?

A

grave if radial nerve avulsion

give case 4-6 weeks until grave prognosis is given

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27
Q

what is a myelodysplasia dysraphism?

A

congenital malformation - incomplete and abnormal fusion of neural tube win sagittal plane - bunny hopping

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28
Q

what breed is predisposed to a myelodysplasia dysraphism ?

A

weimaraner

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29
Q

what is the treatment for a myelodysplasia dysraphism?

A

no treatment
not in pain and doesnt progress

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30
Q

what are methods of cranial reconstruction, protection of meninges?

A

Meninges:
direct suturing
fascia temporalis
porcine SIS

Cranium:
Replacement of excised skull bone or calvarial allografts
acrylic cranioplasty
metallic mesh

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31
Q

what is most informative/sensitive test for evaluating cauda equine syndrome?

A

somatosensory evoked potenitals

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32
Q

list four variant radiographic studies that can be used to evaluate LSS
advantages/disadvantages of each?

A

venography - can have tech errors

myelography - limited due to location of enddural sac (cant evaluate LS IVD vs LS IV foramen)

epidurography - easier/superior to myelographs and less side effects

discography - inject into NP; could lead to IVD degeneration

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33
Q

for LS fracture/subluxation - affected dogs can have up to ____% displacement of canal without major neuro deficits

A

100%

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34
Q

list reported techniques to repair LS fractures

A
  • transilial pinning
  • modified segmental spinal instrumentation
  • combined Kirschner-ehmer/dorsal spinal plate fixation
  • pins/screws and PMMA
  • locking plate (SOP)
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35
Q

where to focus pins on LS fracture?

A

cranial - implants intact pedicles and body L7

caudal - implant sacrum, tuber sacrale, body of ilium

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36
Q

what are the 2 approaches to pituitary?

A

transcrally (transphenioidally)
ventral paramedian

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37
Q

list complications to (short vs long) of cranial sx?

A

short term:
- aspiration pneumonia
- seizures
- recurrence intracranial bleeding
- increased ICF

long term:
- infection
- pneumocephalus
- compression brain secondary to fibrous tissue or overlying musculature

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38
Q

what is the difference in pathophysiology for non communication, communicating, and compensatory for secondary hydrocephalus?

A

non communicating: obstruction of flow from ventricles to SAS

communicating: decreased resorption by arachnoid villi or increased production of CSF

compensatory: loss of brain parenchyma

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39
Q

list three approaches to foraminotomy: advantages vs disadvantages

A

dorsal laminectomy:
- to see IV foramen.
- can’t see L7 nerve root exit well

lateral approach:
- with foraminotomy created from lateral side and direct to vertebral canal.
- dont directly observe cauda equina. - tough to see entry zone of foramen

osteotomy of wing of ilium:
- not used yet

lateral approach:
- access IVD and foramen and dont affect ZPJ

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40
Q

how can you improve visibility for foraminotomy for dorsal laminectomy?

A

remove medial part of caudal articular process L7

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41
Q

durotomy decreases ICP by ___% versus 15% by craniotomy alone?

A

65%

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42
Q

which vertebral neoplasms are chemo responsive or at least reported to be?

A

lymphoma, plasma cell tumor, OSA, multiple myeloma

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43
Q

list extradural noeplasma of vertebra?

A

osa, lymphoma, histiocytic sarcoma complex, infiltrative lipoma, myxoma, calcinosis circumscripta, osteochondroma, chondrosarcoma

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44
Q

list intradural/extramedullary neoplasms of vertebra?

A

meningioma, nerve sheath tumor, extrarenal (ependymoma, neuropeithelioma)

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45
Q

list intramedullary tumors of vertebra?

A

ependyma, glia for primary origin, metastatic for secondary, astrocytoma

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46
Q

what breeds are overrepresented with histiocytic sarcoma complex?

A

Bernese mt dogs, golden, rott, flat-coated retriever

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47
Q

MST for histiocytic sarcoma complex?

A

3-4 months

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48
Q

recurrence rate of infiltrative lipoma

A

36-50%

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49
Q

what is a myxoma? breeds that are overrepresented?

A

rare tumor of synovium

dobies and labs.

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50
Q

ventrolateral stabismus from what nerve injury?

A

oculomotor

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51
Q

medial stabismus fro what nerve injury?

A

abducens

52
Q

eyeball extersion (rotation) from what nerve injury?

A

trochlear

53
Q

lateral rotation of dorsal pupil in cats?

A

trochlear

54
Q

what is the function of CN IX-XII?

A

IX: glossopharungeal - sensory and motor to pharynx

X: vagus - sensory and motor to pharynx, larynx, and viscera

XI: Accessory:
- external branch - trapezius
- internal branch - joint CN X to innervate larynx

XII: hypoglossal - motor to tongue

55
Q

For junctionapathies, what are motor units involved with:
- presynaptic
- synaptic
-postsynaptic

A

pre - transmitter synthesis and/or release

synaptic - acetylcholinesterase

post - acetylcholine receptor

56
Q

what/describe classifications of nerve injury?

A

Class 1: neuropraxia - interrupt function and conduction of nerve without structural changes; reversible

Class 2: axonotmesis - crush and percussion ( internal architecture of nerve preserved - good recovery )

Class 3: neurotmesis - disruption axon/endoneurium but intact perineurium)

Class 4: neurotmesis - disruption axons, endoneurium, perineurium

Class 5: neurotmesis - nerve is severed

Class 6: combines others per fascicle

57
Q

what is the purpose of balanced steady - state?

A

cardiac, orthopedic, and T2-like applications - high contrast of fluid structures.

useful for CNs, inner ear, CNS movement and assessing CNs as course through subarachnoid space

58
Q

what has been suggested as risk factors for UTI post op treatment IVDD?

A

need for bladder evacuations (not catheterization)

prophylactic use of antibiotics during catheterization

NOT sex

59
Q

what are acceptable postvoid US urinary bladder diameters?

A

dogs <30kgs - 3 cm
dogs >30kgs - 4-5 cm

60
Q

what is the normal range of ICP?

A

5-12 mmHg

61
Q

what is normal cerebral blood flow?

A

75.9ml/min/100g

62
Q

autoregulation falls in MAP <___mmHg?

A

MAP < 60mmHg

63
Q

PaCO2 should be kept ~_______ mmHg?

A

30 mmHg

64
Q

PaO2 has effect on CBF once <____mmHg?

A

50 mmHg

65
Q

what is normal dog cerebral metabolic rate? how much make ATP?

A

3.5 ml/min/100g (60% to make ATP)

66
Q

what is the benefit of a spoiled gradient echo?

A

produce T1W images faster

also can use with T2 to detect stages of Hb without blood clot

67
Q

what is the benefit of diffusion-weight imaging? perfusion imaging?

A

demonstrates restricted diffusion of H2) in ischemic strokes or cell neoplasm, abscesses, epidermoid cyst, cholesteatomas

helps for stroke management

68
Q

list congenital/developmental anomalies of AA joint

A

dysplasia (34%),
hypoplasia or aplasia (46%)
dorsal angulation
separation of dens
absences of transverse ligament
incomplete ossification atlas
block vertebrae

69
Q

what breeds most commonly affected by AAI?

A

yorkies, chi, mini poodles, poms, pekingese (large breed - poodles)

70
Q

what % of dogs with AAI have postural reaction abnormalities?

A

56%

71
Q

what % are tetraplegic?
what % have gait abnormalities

A

40%
94%

72
Q

what is the lateral vertebral foramen?

A

perforates craniodorsal part of vertebral dorsal arch of atlast

73
Q

what passes through lateral vertebral foramen?

A

1 st cervical nerve and vertebral artery? (Tobias just says vasculature)

74
Q

what are the ligaments that attach to the dens?

A

apical ligament - attaches to basiooccipital bone

bilateral alar ligament - attached to occipital condyles

75
Q

what ligaments that attach to the dens are most important to protect against VD shearing forces?

A

alar

76
Q

what % of cervical function are C1/C2?

A

50-70%

77
Q

what is periop mortality rate for surgical treatment of cervical fracture?

A

10-35%

78
Q

what is the most common cause of death for cervical fracture? second most common?

A

cardiopulmonary arrest
respiratory dysfunction

79
Q

what is the average ideal insertion angle for C3-C6 vertebrae? (Watire 2006) C7?

A

34.2 - 37.5%

C7 - 47.5%

80
Q

what is the morbidity rate for dorsal laminectomy for CSM?

A

65-78% will be worse postop

81
Q

what are risk factors for high rate of morbidity?

A

diagnosis of osseous associated, more severe neuro status, prolonged sx time.

82
Q

success rate for dorsal laminectomy?

A

79-95%

83
Q

% of recurrence rate followin dorsal laminectomy?

A

30%

84
Q

what were original pin trajectories for cervical fracture repair?

A

~20-35%

85
Q

what CT finding simulation show violated vertebral canal at 30, 35, 40 degrees?

A

30 - 58%
35 - 41%
40 - 33%

86
Q

describe pins insertion for C2 specifically?

A

craniolateral direction C2 - C1
30-35% in sagittal plane
40-45% transverse

use point just medial to alar notch and transverse foramen C1)

Caudal C2 - lateral 30-50%

87
Q

what is prognosis for AAI treatment (conservative)? mortality rate?

A

38% good outcome with medical management

mortality 4-30%

88
Q

outcome for dorsal vs ventral AAI treatment

A

dorsal:
- good to excellent 61%
- dorsal wire loop 52% success
- Kishlgromi 75% toy breed excellent

ventral:
- good to excellent 47-92%
-transcutaneous pin alone - 47%
-pins + PMMA - neuro improvement 94%. complication 34%
- transarticular screw lag fashion 90% success in one study; 40% in another

89
Q

what are some risk factors for outcome reported?

A

age of onset SA with odds success
duration (<10months)
severity of clinical signs SA with odds success

90
Q

what % have single site in large vs giants dogs for CSM?

A

50% single site - large breed
20% single site - giant breed

91
Q

what is the most common site?

A

C6-C7 most common (large breed)

(giant breeds) 80% being one of the sites in C4-C7

92
Q

what % reported T1-T2 and C7-T1 CSM?

A

T1-T2 - 14.3% giant breeds

C7-T1 22.8% all dogs

93
Q

how often is nerve root signature present in cervical IVDD?

A

22-50%

94
Q

what % are cervical IVDD acute onset?

A

45%

95
Q

what % of cervical IVDD patients are :
- non ambulatory tetraparesis?
- ambulatory tetraparetic
- tetraplegia

A

non ambulatory - 11-22%
ambulatory - 42%
tetraplegia - 2-7%

96
Q

what % of cervical IVDD patients have reduced/absent reflex with cranial lesions?

A

34% (usually dogs < 10kg)

97
Q

what are reported complications of CSM (cervical spondylomyelopathy) surgery? rates?

A
  • neuro deterioration (dorsal - 70%, ventral 42%)
  • vertebral forament/transverse foramina penetration 25-57%
  • adjacent segment syndrome (domino effect); 20% primary with distraction and stabilization techniques; ventral slot decreases risk occurrence
  • laminectomy membrane (incidence unknown)
  • implant failure (dist/fusion technique 7.5%-30%)
  • collapse of intervertebral foramina
  • insufficient decompression
98
Q

list complications of stabilizing AAI

A
  • neuro deterioration ( manipulation or implant placement)
  • respiratory compromise:
    1) trauma to laryngeal nerve
    2) compound BOAS
    3) tracheal compression
    4) tracheal necrosis
    5) aspiration pneumonia
  • implant failure
    -fracture of atlas or axis
  • recurrent pain
  • persistent neuro deficits
99
Q

what are general complication rates up to ____ for dorsal vs ventral?

A

dorsal - 71%
ventral - 53%

100
Q

list decompressive techniques for CSM?

A

DIRECT:
V slot
dorsal laminectomy
hemilaminectomy
dorsal laminoplasty

INDIRECT:
vertebral distraction

101
Q

list methods of distraction-stabilization for CSM?

A

Pins and PMMA
screw-bar PMMA
PMMA plug (w or w/o retention screw)
LCP
titanium cage and screw
IV spacer with screw
IV traction screw
IV cage

102
Q

what is one motion-pressuring technique for treatment of CSM?

A

cervical disc arthroplasty

103
Q

what is spina bifida:
occulta
cystica
aperta

A

occulta: no external evidence of malformation (skin dimple/whorling of hair)

cystica: concurrent existence fo meningocele, meningomyelocele, myeloschisis

aperta: open dysraphic/mylodysplastic disccidas
Manx, screw tail breeds

104
Q

what is a dermoid sinus? common breed?

A

skin doesn’t separate from neural tube

Rhodesian ridgebacks
Burmese

105
Q

Describe pin placement for pin + PMMA stabilizing of T-L fractures?

A

entry point T spine - level accessory process/tubercle of rib

entry point L spine - level between base of transverse process and accessory process

pin direction lateral to medial dorsal to ventral
- direct cranial for cranial vertebrae
- direct caudal to caudal vertebrae

106
Q

Advantages of pin + PMMA stabilizing of TL fracture

A

seats pins within vertebra closer to end plates where vertebral body widest

107
Q

list methods of stabilizing L7-S1 unit for LSS

A
  • screws/pins + PMMA (in body L7/sacrum)
  • dorsal cross pin
  • cortical screws lag fashion across ZPJ
  • SOP Plate
  • pedicle screw rod fixation
  • intrabody fusion device
108
Q

Methods for stabilizing L7-S1 using transarticular screws? what are the guidelines?

A

direct ventrolateral 30-45% relation to sagittal

depth hole not beyond body of sacrum

screw diameter 25% of diameter of articular process

109
Q

what is in rostrotentorial compartment? most common surgical approach?

A
  • cerebral hemispheres, thalamus, hippocampus, olfactory
  • transfrontal (+/- modified), transphenoidal
  • other - unilateral rostrotentorial (+/- zygomatic ostectomy)
110
Q

what is in caudotentorial compartment? most common surgical approach?

A
  • cerebellum, pons, medulla, 4th ventricle
  • suboccipital +/- occlusion transverse venous sinus
  • RARE - ventral to caudal brainstem
111
Q

what do you need to avoid when doing transverse sinus occlusion?

A

dont occlude confluens sinuum

112
Q

L7-S1 is what type of joint?

A

amphiarthrodial - cartilaginous

113
Q

list components that can make up degenerative LS stenosis

A

-Hansen type 2 IVDD
-transition vertebrae
-congenital stenosis of canal or IV foramina
-sacral osteochondrosis
-proliferation of joint capsule or ligaments
- osteophytosis of articular processes
-epidural fibrosis
- instability of/malalignment/subluxation of L7-S1

114
Q

what is iodine contrast dose for brain IV?

A

Brain 400-500mg iodine/kg

115
Q

what is dose for CT myelogram full vs regional? max volume to give?

A

myelogram:
FULL - 0.45 ml/kg
REGIONAL - 0.3 ml/kg

avoid >8ml to avoid risk of seizures

116
Q

what are 3 forms of granulomatous ME?

A

disseminated - rapidly progressive multifocal neuro signs

focal - uncommon; slowly progressive - single space lesion

ocular - acute onset visual impairment; variable pupillary changes; optic nerve swelling

117
Q

what the clinical signs of the 3 forms of granulomatous ME? treatment? prognosis?

A

immunosuppressives (pred, cytosine arabinoside, procarbazine, cyclosporine, mycophenolate, etc)

generally poor long term. favorable short term

focal form survive longer than disseminated form

118
Q

what is prognosis of LS disease with medical management

A

55-79% reported

55% - with NSAID and gabapentin
79% - with epidural methylpred

119
Q

what is surgical treatment for LSS? what are supplemental procedures?

A

dorsal laminectomy

+/- partial discectomy (dorsal annulectomy and nuclear pulpectomy)

+/-foraminotomy

+/- removal of zygapophyseal joint with stabilization post

120
Q

Lymphoma of spine:
in cats

  • what % of all confirmed spinal cord disease is lymphoma
  • what % of all neoplasm in spinal cord is lymphoma?
A

27% of all spinal cord disease

25-38% neoplasms in spinal cord is lymphoma

121
Q

In cats:
what disease is often associated with lymphoma in cats spinal cord?

A

FeLV

122
Q

what is the prognosis for dogs with lymphoma of spine

A

very poor

123
Q

what is the response rate for cats with spinal lymphoma with chemo? MST?

A

70-100%

MST <5-7 months; some >1 year

124
Q

what is the monro-kellie doctrine?

A

features of cranium - increase in volume of one component requires reciprocal decrease in one or more of the others to keep ICP

125
Q

describe differences in tissue attenuation and intensities of T1W vs T2W

A

T1W:
short relax (fat) - bright
long relax (CSF) - dark
normal tissue - grays
other brights: metHb, hemorrhage, mucin, tissues, melanin, ion deposits

T2W:
short relax (muscle) - dark
long relax (CSF) - bright
intermediate (fat) - intermediate
normal tissue - grays
white malta hypointense to gray
other brights: edema, necrosis, cell infiltrate (neoplasm, inflammation)

Phase II Cards from RC (26 decks)

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